Your child should be using a variety of sounds in words and short sentences which are 75% understandable by three years of age to listeners other than family. A sensorimotor impairment of the speech musculature following a stroke may cause a significant impairment in the ability to produce speech sounds. Language development normally progresses from babbling to building a first vocabulary of at least 50 words by age two to making short sentences by two to three years of age. Adults may experience difficulties with understanding and using language following a stroke or head injury. Children sometimes experience dramatic changes in their voice and should be seen for a complete assessment. Adults who experience chronic hoarseness, vocal fatigue, reduced volume, or altered pitch should consult their doctor and a Speech-Language Pathologist. Stuttering is characterized by abnormal stoppage (no sound), repetitions ("st-st-stuttering"), or prolongations ("ssstuttering") of sounds or syllables which may be accompanied by unusual facial or body movements. It may start as early as two years of age. Children and adults with hearing losses can experience difficulties communicating. A Speech-Language Pathologist can help you with communication skills: such as speech, voice quality, language, "lip-reading", sign language, and communication strategies. Literacy skills begin to develop during the preschool years. Children slow to develop early reading and story telling skills may need extra help with rhyming, phonological awareness, and decoding print..